What are the objectives of oral cancer screenings?
to detect cancer of the mouth at the earliest possible stage
When is the prognosis of oral cancer less favorable?
when it is discovered later, and the cancer extends into adjacent structures and to the lymph nodes of the neck
How come early lesions may go unnoticed and unreported by the patient?
because early lesions are generally symptomless
What is the principle method for the control of oral cancer?
observation by the dentist or dental hygienist
True or false. In addition to the early lesions of oral cancers, the oral manifestations of neoplasms elsewhere in the body as well as the oral manifestations of chemotherapy can be recognized.
true or false. Neoplasms may arise at any site in the oral cavity?
What are the most common sites for neoplasms in the oral cavity?
- floor of the mouth
- lateral parts of tongue
- lower lip
- soft palate complex
It is important to teach patients about self examination for oral cancer, but why is it important that we perform a screening on top of that?
because it may be difficult for persons to see their own tissues without help and use of adequate equipment
self examination needs to be supplemented with________________examination on a scheduled basis.
What are 5 basic forms of early cancer described in this chapter?
- white areas
- red areas
White areas indicating early cancer include
- filmy barely visible change to thick dry areas of keratinized tissue
- fissures, ulcers, or areas of induration
what type of white early cancer lesion is most indicative of malignancy?
fissures, ulcers, or areas of induration in a white area
a white patch or plaque that cannot be scraped off or characterized as any other disease. It may be associated with physical or chemical agents and the use of tobacco
True or false. You should note if the white tissue in oral mucosa flakes off.
False. Do not note it if it flakes off unless it's red. Note if white tissue does not flake off
Red areas indicating early cancer include
- velvety consistency
- small ulcers
a term used to designate lesions of the oral mucosa that appear as bright red patches or plaques that cannot be characterized as any specific disease
Ulcers in early cancer may be___________or____________, and palpation can reveal___________.
Describe 2 types of masses indicating early cancer described in this chapter
- papillary masses; sometimes with ulcerated areas, occur as elevations above the surrounding tissues
- other masses may occur below the normal mucosa and may be found only by palpation
What type of pigmentation may indicate early cancer?
brown or black pigmented areas located on mucosa where pigmentation does not normally occur
true or false. Brown or black pigmentation may indicate more advanced stages of oral cancer.
Name 2 types of dyes that can aid in diagnosing cancer
- toluidine blue
The removal and examination, usually by microscope, of a section of tissue or other material from the living body for the purpose of diagnosis.
biopsy where the entire lesion is removed
biopsy when a representative section from the lesion is taken
What are 4 indications for biopsy of a lesion?
- unusual oral lesion that can't be identified with clinical certainty
- lesion that has not shown any healing in 2 weeks
- a persistent thick, white, hyperkeratotic lesion and any mass that does not break through the surface epithelium
- any tissue that is surgically removed
a diagnostic aid in which surface cells of a suspicious lesion are removed for microscopic evaluation
cytologic smear technique
What are 2 indications for when the smear technique should be used for a lesion?
- for lesions which a biopsy is not planned, except for keratotic lesions that are not suitable for exfoliative cytology
- used if a pt refuses a biopsy
What are 5 applications for the cytologic smear?
- follow up exam for pts with oral cancer and treated with radiation
- can identify candida albicans organisms in pts (lesion not going away)
- can identify herpes virus
- can be used for mass community screenings
- research studies
In a lab report what does that unsatisfactory classification indicate about a specimen?
slide is inadequate for diagnosis. The specimen may have been too thick or thin, or the cells may have dried before fixation
What does class 1 of a speciman in a lab report indicate?
What does class II of a specimen in a lab report indicate?
atypical, but not suggestive of malignant cells
What does class III of a specimen in a lab report indicate?
uncertain (possible for cancer)
What does class IV of a speciman in a lab report indicate?
probable for cancer
What does class V of a specimen in a lab report indicate?
positive for cancer
Follow up report of class IV or V
refer for biopsy
Follow up report of class III
reevaluate clinical findings; biopsy usually indicated
Follow up report of class I or II
- the pt must not be dismissed until the lesion is healed
- When the lesion persists, the dentist either reevaluates the clinical findings and requests a repeat cytologic smear or performs a biobsy
Follow up report of a negative cancer report
- either biopsy or smear requires careful follow up if negative report is obtained
- false negative reports are possible